Decision Aids in Primary Healthcare - Needs and Experiences

Mafalda Proença-Portugal, Bruno Heleno, Sónia Dias, Ana Gama, Sofia Baptista

Keywords: Decision aids, focus groups, primary healthcare, shared decision making, qualitative study

Background:

Decision aids (DA) are evidence-based tools that support shared decision-making, promoting an active role of patients in health decisions. Portuguese clinical guidelines are tools for clinical decision-making but have a low incorporation of patients’ values and perspectives. However, the complexity of available information and the ambiguity between choices call for the patients’ participation in the decision-making process. DA adopted to the Portuguese reality could be useful in the primary healthcare (PHC).

Research questions:

To explore the perception of health professionals about DA and their utility within the scope of PHC in Portugal; to identify barriers and facilitators to the implementation of DA in clinical practice; and to identify clinical topics that would benefit from translation and cultural adaptation.

Method:

Qualitative study. Seven focus groups were held with 33 general practitioners and residents (more than 6 months of residency). Discussions were recorded, transcribed, and anonymised, then thematically analysed by two authors independently. The study was approved by the Regional Health Administration of Lisbon and Tagus Valley Health Ethics Committee.

Results:

Most participants were not familiar with the concept of DA. All participants mentioned that DAs support the professional's clinical decision and only one mentioned their potential supporting shared decision-making with their patients. Participants generally revealed a positive attitude towards the use of DA. Concerns surrounded the lack of funding and need of longer consultation time. Participants mentioned as facilitators: the possibility of integrating these tools into computer systems and their translation and adaptation to the Portuguese population. Younger and more literate patients were considered to be the most receptive to DA. Clinical topics of interest included screening, diagnosis and treatment.

Conclusions:

Despite unfamiliar to most participants, integrating DA in PHC was well received and these may provide a potential added value regarding the provision of healthcare to patients

Points for discussion:

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